access policy practice advice: autism spectrum disorder · web viewthe asrs items are also linked...

Access Policy Practice Advice: Autism Spectrum Disorder

October 2011 (Version 2)

Department of Human Services

ContentsPurpose of the guide..............................................................................................................

Part One................................................................................................................................

What is Autism Spectrum Disorder?..................................................................................

How do we know someone has ASD?...............................................................................

Who can make a diagnostic assessment of ASD?............................................................

Complex presentations of ASD..........................................................................................

Formal assessment tools in relation to ASD that may be used in

diagnostic reports...............................................................................................................

Part Two................................................................................................................................

Key issues to consider that can make determining whether a

person with ASD is within the target group for Disability Services

difficult................................................................................................................................

Part Three............................................................................................................................

Determining if a person with ASD is within the target group for

disability services.............................................................................................................

(i) Is ASD “permanent, or likely to be permanent”?.....................................................

(ii) Is there evidence of “a substantially reduced capacity in at least one of the areas of self-care, self-management, mobility or communication?..................................................................................

(iii) Does the individual require “significant ongoing or long term episodic support”?.................................................................................................

(iv) Is the impairment “related to ageing”?..................................................................

Appendix A Autism assessment tools................................................................................

Appendix B Adaptive Behaviour Measures.......................................................................

Appendix C Behaviour Measure........................................................................................

Appendix D Eligibility for Medicare Rebate to access diagnosis and

treatment..............................................................................................................................

Appendix E Useful contacts...............................................................................................

Appendix F Recommended reading and resources..........................................................

Access Policy Practice Advice: Autism Spectrum Disorder (Version 2)2

Purpose of the guide

The Victorian Government acknowledged Autism Spectrum Disorder (ASD) as a

neurological impairment under the Disability Act 2006 (the Act) in December 2008. This has

allowed all people with ASD to be considered for access to disability services.

In order for a person with ASD to be considered as within the target group for disability

services under the Act, the associated impact of the person’s ASD must be considered.

The purpose of this guide is to help Department of Human Services staff, and staff in

community service organisations, to determine whether a person is within target group to

receive services as outlined in the Act.

This guide has been divided into three parts:

Part One

This section details what is meant by ASD and how it is diagnosed.

Part Two

This section highlights the key issues that can make determining whether a person with ASD

is within the target group for Disability Services difficult.

Part Three

This section has been designed to assist staff to gather the information required to determine

if the person with ASD is within the target group for disability services. In particular, guidance

is provided regarding the associated impact of the ASD and where information regarding

these impacts can be found.


Part OneWhat is Autism Spectrum Disorder?Autism Spectrum Disorder (ASD) is the term used to describe a continuum or spectrum of

neurological conditions characterised by marked impairments in

- social interaction

- communication

- restricted repetitive patterns of behaviours, interests, and activities.

Although individuals with ASD have core commonalities, they also can have a range of

presentations within these core areas. This is one of the reasons that the condition is

referred to as a continuum or spectrum.

Autism Spectrum Disorder (ASD) encompasses:

1. Autistic Disorder

2. Asperger’s Disorder

3. Pervasive Developmental Disorder Not Otherwise Specified

Autistic Disorder

The diagnostic criteria for Autistic Disorder are:

(1) qualitative impairment in social interaction,

(2) qualitative impairment in communication, and

(3) restricted repetitive and stereotyped patterns of behaviour, interests, and

activities,

with onset prior to 3 years of age.

“High Functioning Autism” is another term that is sometimes used. Generally this diagnosis

is used to refer to children diagnosed with Autistic Disorder who have delayed language but

who later develop language and who have overall intellectual ability above 65-70 on a

standardised intelligence test.

Asperger’s Disorder

The diagnostic criteria for Asperger’s Disorder are:

(1) qualitative impairment in social interaction, and

(2) restricted repetitive and stereotyped patterns of behaviour, interests, and

activities.

These criteria are also criteria for Autistic Disorder. However, the criteria for Asperger’s

Disorder do not include the criterion that there is qualitative impairment in communication.


The criterion for Asperger’s Disorder is that there is no clinically significant general delay in

language. However, individuals with Asperger’s Disorder do have difficulty with social

language. This is sometimes referred to as pragmatic language difficulties.

Further criteria for Asperger’s Disorder are that there is no clinically significant delay in

cognitive development or in the development of age-appropriate self-help skills, adaptive

behaviour (other than in social interaction), and curiosity about the environment in childhood. However, there is debate in relation to the criterion of there being no significant delay in self-

help skills and adaptive behaviour for the diagnosis of Asperger’s Disorder. This guide

recommends that difficulty with self-help skills and adaptive behaviour should be considered

as a presentation of Asperger’s Disorder.

Pervasive Developmental Disorder Not Otherwise Specified

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) is a diagnostic

category that can be used when an individual demonstrates severe impairment in social

interaction but not enough clear signs in relation to communication impairment or repetitive

behaviours for the diagnosis of Autistic Disorder or Asperger’s Disorder.

How do we know someone has ASD?The first step for the disability intake worker is to confirm that a client has a diagnosis of ASD

and that this has been adequately confirmed.

Given that ASD is a developmental condition, there will have been evidence of the condition

in the individual’s early development. Usually a diagnosis of ASD will have been made some

time in the individual’s childhood but this is not always the case.

Who can make a diagnostic assessment of ASD?The assessment of an individual with ASD should involve a team of medical and allied health

professionals knowledgeable in the diagnosis of ASD. The multi-disciplinary team usually

comprises of a paediatrician and/or a child psychiatrist, a psychologist, and a speech

pathologist. These are the ‘core disciplines’ that represent the skills necessary to address

the diagnostic criteria; however, in some teams an occupational therapist may also be

included.

Team assessment does not necessarily mean that a group of service providers must work in

the same agency, but it does reflect that ‘collaboration’ is necessary between the

professionals. However, in some cases team assessment may not be necessary. For

example, if a verbally able adult seeks assessment from a psychiatrist or psychologist very

knowledgeable in the field it may not be necessary for a language assessment to be sought.

The guiding principal is that a team assessment should be sought if possible and that all

professionals involved should have had wide experience in autism assessment. Where a

diagnostic assessment is provided from only one practitioner it is recommended that

additional information is sought as to why this is the case and whether broader assessment

is required.


A diagnostic report may be prepared as a single collaborative report or prepared individually

by team members; however, the report should reflect team member’s opinion. Report/s need

to include a detailed developmental history, intellectual assessment, and specific ASD

assessment. It is also very helpful if the report includes assessment of the individual’s

adaptive behaviour, but this may not always be included in a diagnostic report. If a detailed

collaborative diagnostic report is not available to the disability intake worker then this may

need to be sought.

Complex presentations of ASDAs mentioned, sometimes an individual will not have been diagnosed in childhood and a

diagnosis is not made until later in childhood, in adolescence, or even sometimes in

adulthood. The most likely reason for late diagnosis is that the individual had been

diagnosed previously with a developmental condition frequently associated with ASD (for

example, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, or

Tourette’s Disorder), and their ASD has been overlooked. Sometimes the individual has

been misdiagnosed earlier, or sometimes the individual may have both conditions (e.g. ASD

and Attention Deficit Hyperactivity Disorder). If a diagnosis of ASD is made later in a

person’s life, developmental information from earlier in the person’s life still needs to be

gathered by the clinicians involved in diagnosis and be evident in the assessment report.

It is also possible that a mental health diagnosis (such as Schizophrenia, or Obsessive

Compulsive Disorder) could have been given to a young adult or adult but ASD is later

diagnosed. This can occur if a previous clinician was focussed on the client’s present

presentation and did not look adequately at the client’s early developmental history. Again, it

is possible that a previous misdiagnosis was made or that the client actually has both

conditions.

These are difficult issues in relation to a client and disability intake workers may need to

seek further assessment or opinion from a psychologist or psychiatrist who is knowledgeable

in regard to ASD and complex presentations.


Formal assessment tools in relation to ASD that may be used in diagnostic reportsThere are a number of well-standardised assessment tools with demonstrated reliability and

validity that can be used in a diagnostic assessment. Sometimes assessment may include

the use of a tool that can screen for the possibility of ASD (e.g. the Developmental Behaviour

Checklist Early Screen (DBC-ES) and the Developmental Behaviour Checklist Autism

Screening Algorithm (DBC-ASA), Autism Spectrum Screening Questionnaire (ASSQ), the

Australian Scale for Asperger’s Syndrome (ASAS). However, if a screening assessment tool

has indicated the possibility of ASD follow-up diagnostic assessment is still needed. The

following diagnostic assessment tools are frequently used:

Diagnostic Assessment Tool Age Range Applicability

Autism Diagnostic Interview- Revised (ADI-

R)Early childhood to adult

Autism Diagnostic Observation Schedule

(ADOS)Early childhood to adult

Diagnostic Interview for Social and

Communication Disorders (DISCO)Early childhood to adult

Childhood Autism Rating Scale, Second

Edition (CARS-2)

Early childhood to adult

Psycho-Educational Profile - Third Edition

(PEP- 3)Infants 6 months to 7 years of age

Autism Spectrum Rating Scale (ASRS) 2 to 18 years of age

Social Responsiveness Scale (SRS) 4 to 18 years of age

More detailed information about these measures is given in Appendix A.


Part TwoKey issues to consider that can make determining whether a person with ASD is within the target group for Disability Services difficult.

Individuals with ASD have a range of abilities across various areas, as well as additional

conditions commonly associated with ASD. This variation can make it difficult for disability

workers to determine whether a person with ASD meets the criteria set out in the Act. Given

the possible variation in presentation, the following points should be kept in mind:

Individuals with ASD have a range of intellectual ability.

Average or near-average intellectual ability does not mean that the individual has

similarly average or near-average adaptive behaviour.

Individuals with ASD have a range of language ability.

An individual with ASD can have receptive and/or expressive language deficits even

if their intellectual ability is not low overall. However, in this case, their intellectual

profile on a formal assessment will indicate poor verbal skills as part of a scale or

index score.

When verbal skills appear intact, individuals with ASD will have ‘pragmatic’ language

deficits. These are deficits in the ability to engage in language for social purposes.

Average or near-average intellectual ability does not mean that the individual has

similarly average or near-average literacy or numeracy ability. The individual may

have a Specific Learning Disability in relation to literacy and/or numeracy ability and

may demonstrate very low skills in these areas. It is also important to realise that an

individual can have marked deficits in relation to literacy skills even if they appear to

have quite good oral verbal language skills.

Individuals with ASD vary in their auditory memory ability. Only part of an

individual’s intellectual ability profile will indicate their verbal (auditory) memory

ability. It is important to identify if an individual has deficits in verbal memory as

these deficits can have a profound affect on an individual’s everyday functioning

ability.

Individuals with ASD have executive functioning deficits; however, the severity of

executive functioning deficits can vary in different individuals. Executive functioning

is a term used to describe a collection of processes mediated by the frontal lobes of

the brain. These skills include the ability to initiate behaviour, to plan and organise,

and to shift problem solving strategies flexibly, when necessary. Such skills are

required in many daily living skills.


Most individuals with ASD have sensory processing difficulties; however, the range

and severity will vary. Sensory processing difficulties may have an impact on the

individual’s ability to perform some adaptive tasks.

Individuals with ASD can also have a number of additional difficulties. It has been

found that ASD can frequently co-occur with mental health issues. One of the main

areas of additional difficulty for individuals with ASD is in relation to anxiety and

depression.


Part ThreeDetermining if a person with ASD is within the target group for disability services

The Disability Act 2006 defines disability as follows:

Disability in relation to a person means-

a) a sensory, physical or neurological impairment or acquired brain injury or any combination

thereof, which –

i) is, or is likely to be permanent; and

ii) causes a substantially reduced capacity in at least one of the areas of self-

care, self-management, mobility or communication; and

iii) requires significant ongoing or long term episodic support; and

iv) is not related to ageing; or

b) an intellectual disability; or

c) a developmental delay.

ASD is considered to be a neurological impairment within the definition above. Individuals

with ASD must therefore meet the four criteria (a) i – iv) to be considered as having a

disability in accordance with the Disability Act 2006. This section of the guide focuses on

determining if a person with ASD meets these criteria.

(i) Is ASD “permanent, or likely to be permanent”?Yes. ASD is identifiable as development unfolds during the first years of a person’s life or in

the person’s early childhood. For this reason ASD is sometimes called a neuro-

developmental disability. An unusual developmental pattern is manifest in cognitive and

behavioural differences throughout the person’s life. The neurological impairment may

change in expression over the course of the person’s life but the underlying neurological

impairment is permanent. For this reason a diagnosis of ASD that is made early in a child’s

life is still a reliable indication of the disability being present throughout their life.

(ii) Is there evidence of “a substantially reduced capacity in at least one of the areas of self-care, self-management, mobility or communication?For each of these areas of adaptive behaviour questions which may help to determine

whether an individual with ASD has substantially reduced capacity are provided.

Key point:

It is important to note that it may not be possible to determine the adaptive behaviour skills of

an individual with ASD simply by asking the individual to answer questions. The individual

with ASD may not fully understand the question, or they may answer as they think they

should. In such cases, it is necessary to determine the adaptive behaviour skills of the

individual by using and adaptive behaviour assessment tool, and preferably gathering this


information from multiple sources (e.g. the individual, a teacher, and a parent/carer who

knows the individual well).

In addition, if previous information from an adaptive behaviour assessment is relied upon to

determine if an individual with ASD has substantially reduced adaptive behaviour skills, it is

suggested that the assessment/report should not be more than two years old, given that

adaptive behaviour skills can change over time.

There are a number of well-standardised adaptive behaviour measures with demonstrated

reliability and validity that can be used by clinicians working with individuals with ASD. All

clinicians using the assessment tool need to have had appropriate training in its use. The

following adaptive behaviour measures are commonly used:

Adaptive Behaviour Measure Age Range Applicability

Adaptive Behaviour Assessment System –

Second Edition (ABAS-II)

Birth to 89 years

Scales of Independent Behaviour – Revised

(SIB-R)

Early infancy to beyond 80 years

Vineland Adaptive Behaviour Scales,

Second Edition (Vineland-II)

Birth to 90 years

Each of these assessment tools provides standard scores and percentile ranks in particular

areas of adaptive behaviour for the individual being assessed. Sometimes adaptive levels

are given in terms of an age score and these can be helpful in giving an idea of the ability of

the individual to tackle age level tasks, but they do not, in themselves, indicate whether the

individual’s ability is substantially reduced in terms of statistical norms based on

chronological age expectations.

Key point:

The adaptive behaviour of the individual is defined as being “substantially reduced” if the

standard score or percentile rank is at least two standard deviations below the mean.

Standard scores in each of these tests have a mean of 100 and a standard deviation of 15,

so a standard score of 70 or below shows substantially reduced adaptive behaviour.

However, it needs to be noted that in adaptive assessments, standard scores are given in

terms of overall (or global) adaptive behaviour AND in terms of specific adaptive areas.

Therefore, someone’s overall adaptive behaviour could be assessed as being at a standard

score of above 70 and not substantially reduced overall, but still be lower than 70 and

‘substantially reduced’ in one or more of the specific areas of self-care, self-management,

communication, and mobility.


Relevant sections of adaptive behaviour measures are referred to under adaptive behaviour

category below. More detailed information about these measures is given in Appendix B.

Self-careOne of the main cognitive problems that individuals with ASD have is in relation to executive

functioning skills. These skills include the ability to initiate behaviour, the ability to plan and

organise, and the ability to shift problem solving strategies flexibly when necessary. Such

skills are required in many daily living skills (e.g. planning what to buy from the supermarket

to prepare a meal or organising how to prepare and cook the different parts of the meal).

In addition, an individual with ASD has neurological deficits in social understanding. This

means that they may not have the same social motivation to perform self-care tasks as other

individuals. Accordingly, it has been found that individuals with ASD have markedly lower

levels of adaptive behaviour than predicted by their intellectual ability.

In determining a person’s capacity in self-care (and other areas of functioning) one has to

work out to what extent the individual is able to complete an activity (i.e. minimally, partially,

or fully) if they were to receive no prompting or help. One may also need to determine what

form of prompting has been tried (i.e. verbal or visual prompts).

The following questions are examples of the sort of questions asked in adaptive behaviour

measures of self-care. The questions pertain to a range of developmentally sequenced

abilities. However, in order to determine whether an individual with ASD has a substantially

reduced capacity in self-care compared with other individuals of a similar age one needs to

use a standardised measure.

- Is the individual able to cut food with a knife to eat appropriately sized pieces?

- Is the individual able to prepare a simple uncooked snack?

- Is the individual able to plan and organize purchasing the food they need to prepare

meals? Do they prepare simple cooked foods for themselves?

- Do they manage left over food hygienically?

- Do they complete domestic duties frequently enough to maintain a hygienic

environment?

- What is their level of independence in relation to all toileting tasks?

- Are they able to fully dress themselves independently?

- Do they wear clothing appropriate for the weather?

- Do they maintain a neat appearance? How often do they wash their clothes?

- Are they able to bathe or shower without assistance?

- How often do they bathe or shower themselves? Is basic hygiene maintained? Is

body odour a problem?

- Do they care for their basic health needs (e.g. selecting and buying personal care

items such as soap, shampoo, bandaids)?


- Do they make an appointment to see a health professional (e.g. doctor, dentist) if this

is necessary?

Key point:

It is possible that the individual will say that they can do something when they do not actually do it. While the

person may know that it is something that they should do, they may find it difficult to initiate or to plan and

organise doing it. They also may not have the social motivation to do it, and may be more drawn to

undertaking a preferred repetitive behaviour. In such cases it is necessary to consider the relevant sections of

an assessment based on an adaptive behaviour measure and to determine what they actually do.

Relevant sections of adaptive behaviour measures are as follows:

- SIB-R

In the SIB-R, self-care skills are assessed in the Personal Living Skills cluster which consists

of the subscales of Eating and Meal Preparation, Toileting, Dressing, Personal Self-Care,

and Domestic Skills. The standard score and percentile rank is given for the whole Personal

Living Scales cluster (mean of 100 and standard deviation of 15). In the SIB-R the cluster

Personal Living Skills is made up of subscales that are all relevant indicators of overall self-

care skills. A standard score of 70 or below indicates substantially reduced self-care

capacity. Refer to Appendix B for further details about a number of additional scores given in

the SIB-R.

- Vineland-II

In the Vineland-II, self-care skills are assessed in the Personal and Domestic sub-domains

within the Daily Living Skills domain. The Daily Living Skills domain is reported as a

standard score (mean of 100 and standard deviation of 15) so a standard score of 70 or

below in the Daily Living Skills domain is a good indicator of substantially reduced self-care

capacity. The individual’s capacity in the sub-domains of ‘Personal’ and ‘Domestic’ are

particularly relevant to an individual’s self-care capacity and can also be looked at. The sub-

domains are reported as a v-Scale Score (mean of 15 and standard deviation of 3) so a

score of 9 or lower indicates substantially reduced capacity. Further details are in Appendix

B.

- ABAS-II

In the ABAS-II, self-care skills are assessed within the Practical composite domain and

particularly in the sub-domains of Self-care, Home Living, and Health and Safety. In the

ABAS-II the composite domain scores are reported as having a mean standard score of 100


and a standard deviation of 15, so a standard score of 70 or below in the Practical composite

score is a good indicator of substantially reduced self-care capacity. The individual’s capacity

in the sub-domains of ‘Self-care’, ‘Home Living’, and ‘Health and Safety’ are particularly

relevant to an individual’s self-care capacity and can also be looked at. The sub-domains

have a mean of 10 and a standard deviation of 3, so a score of 4 or lower indicates

substantially reduced self-care capacity. Further details are in Appendix B.


Self-managementAs individuals with ASD have a deficit in executive functioning skills, they can have reduced

capacity in relation to self-management (e.g. they may have difficulty planning an everyday

task such as keeping an appointment). They can also have a range of other difficulties that

impinge on self management skills. For example, it is not uncommon for individuals who

have ASD to have sleep difficulties and to not have regular sleep patterns. This in turn may

affect their capacity to get to work on time.

Unexplained decreases in self-management and other everyday living skills over time may

be indicators of behavioural and emotional disturbance increasing. It has also been found

that individuals with ASD who do not have an intellectual disability have an even higher

likelihood of behavioural and emotional disturbance. This may be explained by assuming that

these individuals have a greater understanding that they are having difficulty managing in

social situations.


measures of self-management. The questions pertain to a range of developmentally

sequenced abilities. However, in order to determine whether an individual with ASD has a

substantially reduced capacity in self-management skills compared with other people of a

similar age one needs to use a standardised measure.

- Is the individual able to read?

- Does the individual have an understanding of numbers and are they able to make

simple calculations?

- Does the individual have an understanding of the concept of time?

- Does the individual refer to a clock and use a calendar?

- Is the individual able to manage getting to bed by a certain time so that they can get up

at an appropriate time the next day to fulfil responsibilities?

- Does the individual have difficulty with any aspects of memory? Does the individual

manage their daily affairs through the use of a diary or other form of planner?

- What level of independence is possible in terms of making appointments that are

necessary (e.g. seeing a doctor)?

- Is the individual able to recognise money denominations?

- Does the individual have an understanding of the function of money?

- Does the individual understand the value of money and the need to budget?

- What level of financial management of the household is possible? Is the individual

able to manage the household in terms of paying bills on time?

- What level of independence is possible in terms of getting to work? Can the individual

get to work and other appointments on time?

- How does the person manage with unexpected changes in their routines or plans?

- To what extent is the individual able to regulate their emotions?

- To what extent is the individual able to independently weigh the consequences of their

actions before making decisions?


- Does the individual have realistic long-term plans?

Key point:

It may not be possible to determine the individual’s self-management skills simply by

observing the individual in one setting. That particular setting may have relatively little social

or sensory difficulty for them. In such cases it is necessary to consider the relevant sections

of an assessment based on an adaptive behaviour measure and to gather information from

multiple sources about their self-management ability in a variety of settings.


- SIB-R

In the SIB-R, self-management skills are assessed in the Community Living Skills cluster

which consists of the following sub-domains: Time and Punctuality, Money and Value, Work

Skills, and Home/Community Orientation. In the SIB-R the cluster Community Living Skills is

made up of subscales that are all relevant indicators of overall self-management skills. A

standard score and percentile rank is given for the whole Community Living Skills cluster

(mean of 100 and standard deviation of 15). A standard score of 70 or below indicates

substantially reduced self-management capacity. Self-management skills are also assessed

in the Problem Behaviour Scale in the SIB-R. This scale assesses problem behaviours that

are linked to poor personal and social adjustment. In addition, information about

maladaptive behaviour can also be obtained from the SIB-R which may be helpful in relation

to evaluating self-management capacity.

- Vineland-II

In the Vineland-II, self-management skills are assessed in the Community sub-domain,

which is part of the Daily Living Skills domain. The Daily Living Skills domain is reported as a

standard score (mean of 100 and standard deviation of 15), but the sub-domain ‘Community’

is the most relevant to self-management capacity. A sub-domains is reported as a v-Scale

Score (mean of 15 and standard deviation of 3) so a score of 9 or lower indicates

substantially reduced capacity. Problem behaviours are assessed in the Maladaptive

Behaviour Index in the Vineland-II. An understanding of the level of problem behaviours

would also be relevant in evaluating self-management capacity.

- ABAS-II

In the ABAS-II, self-management skills are assessed in the following subtests: within the

Practical domain: Community Use (if age appropriate), and Work Skills (if employed) as well

as within the Conceptual domain in the subtest Self-Direction. In the ABAS-II the composite

domain score for ‘Practical’ and ‘Conceptual’ are reported as having a mean standard score

of 100 and a standard deviation of 15, however, the sub-domains ‘Community Use’, ‘Work


Skills’ and ‘Self-Direction’ are the most relevant in evaluating self-management capacity. The

sub-domains have a mean of 10 and a standard deviation of 3, so a score of 4 or lower

indicates substantially reduced self-management capacity.

A useful assessment tool to determine the associated, emotional, behavioural, and mental

health issues that individuals with ASD are at risk from suffering is the Developmental

Behaviour Checklist (Einfeld & Tonge, 1992, 1995, 2002, in the form completed by

parents/carers, DBC-P; the form completed by teachers, DBC-T; and the form for adults,

DBC-A). Further details are in Appendix C.

For information on local mental health service see Appendix E.

MobilityGross and fine motor difficulties, as well as difficulty with balance, can occur in individuals

with ASD. Some studies point to the prevalence of motor difficulties in higher functioning

individuals who have ASD. Generally these difficulties do not have major effects, but they

can have minor effects in terms of general clumsiness, sporting ability, and ability to ride a

bicycle. Some individuals also have difficulty in terms of hand-writing ability. If gross and

fine motor difficulties are marked, then assessment by an Occupational Therapist is

recommended to precisely determine mobility function.

An individual’s capacity to move about outside the home may also be affected for other

reasons than motor skills. For example, some individuals with ASD have difficulty driving

due to a number of factors such as the high level of concentration needed and the multi-

tasking required. In addition, individuals with ASD frequently have difficulty in unfamiliar

settings.


measures of mobility. The questions pertain to a range of developmentally sequenced

abilities. However, in order to determine whether an individual with ASD has a substantially

reduced capacity in mobility skills compared with other people of a similar age one needs to

use a standardised measure.

- Is the individual able to walk, manage stairs, hop, run, and climb ably?

- Is the individual able to hand-write legibly?

- Is the individual able to carry objects (e.g. grocery items) safely?


Key point:

A disability worker may also need to ascertain if the individual with ASD has reduced self-management skills

substantially caused by their ASD or by an additional layer of behavioural and emotional disturbance that may

be seen as a mental health issue. This is difficult to determine but if the behavioural and emotional disturbance

seems substantial then working in cooperation with a mental health service may also be required.

- Is the individual able to ride a two-wheeler bicycle?

- Is the individual able to drive?

- Is the individual able to manage public transport?

- Is the individual able to safely move about in the community?

- Are there marked additional complicating factors that hinder the individual’s mobility in

the community (e.g. are they able to manage in unfamiliar settings?)

- Is the individual able to hammer and/or manage basic household repairs?

- Does the individual receive support from an Occupational Therapist?


- SIB-R

In the SIB-R, gross and fine motor skills are assessed for all ages.

- Vineland-II

In the Vineland-II, motor skills are only assessed for children who are under 6 years and 11

months, but there is a procedure to estimate motor skill in individuals who are over this age.

- ABAS-II

In the ABAS-II, motor skills are not assessed.

CommunicationSome individuals with ASD who do not have an intellectual disability have receptive and/or

expressive language difficulties. However, generally individuals with ASD who do not have

an intellectual disability have more subtle pragmatic (social) language difficulties. For

example, they may have difficulty in being able to ask for help and in using language

appropriately to support social interaction. They may also tend to understand language

literally.

The pragmatic language difficulties may also include lacking interest in communicating, and

failing to understand the significance of communicating. They may also have difficulty

understanding the non-verbal aspects of communication. In any of these ways, their

language interactions may fail to be effective and mutually engaging.

Social communication also involves having an understanding of what others are thinking

(theory of mind ability) so that one can truly communicate. However, individuals with ASD

have difficulty with theory of mind skills.

Therefore, in evaluating the communication of higher functioning individuals who have ASD,

one has to not simply evaluate spoken language. Rather one needs to evaluate the capacity

of the individual who has ASD for social communication.


measures of communication skills. The questions pertain to a range of developmentally


sequenced abilities. However, in order to determine whether an individual with ASD has a

substantially reduced capacity in communication skills compared with other people of a

similar age one needs to use a standardised measure.


- Can the individual indicate verbally if they want something or don’t want something?

- Does the individual say ‘please’, ‘thank-you’, ‘hello’ and ‘good-bye’ when appropriate?

- Can the individual relate simple experiences and/or initiate conversations?

- Can the individual seek clarification if they have not understood an instruction or

request?

- Does the individual read and understand written material appropriate for their age?

- Can the individual answer a telephone and write down a message if necessary?

- Can the individual follow an instruction with multiple parts?

- Can the individual ask for help?

- Can the individual look up needed information or seek out an appropriate person to

ask for help from (e.g. can they ask for something to be repaired)?

- Does the individual participate appropriately in social situations?

- Does the individual have friends and other meaningful relationships?

- Can the individual maintain relatively amiable relationships in a work environment?


- SIB-R

In the SIB-R, communication skills are assessed in the cluster Social Interaction and

Communication Skills with the subtests of Social Interaction, Language Comprehension, and

Language Expressive. The standard score and percentile rank is given for the whole Social

Interaction and Communication Skills cluster (mean of 100 and standard deviation of 15). In

the SIB-R this cluster is made up of subscales that are all relevant indicators of overall

communication ability. A standard score of 70 or below indicates substantially reduced

communication capacity.

- Vineland-II

In the Vineland-II, communication skills are assessed in two domains. These are the

Communication domain which includes the sub-domains of Receptive, Expressive, and

Written skills. They are also assessed in the Socialization domain in the sub-domains

Interpersonal Relationships, Play and Leisure time, and Coping Skills. The domain scores

are reported as a standard score (mean of 100 and standard deviation of 15), so a standard

score of 70 or below in the Communication domain is a good indicator of substantially

reduced communication capacity. A standard score of 70 or below in the Socialization

domain may also indicate that poor skills in this area are related to poor communication skill

capacity. The individual’s capacity in each of the relevant sub-domains can also be looked

at. The sub-domains are reported as a v-Scale Score (mean of 15 and standard deviation of

3) so a score of 9 or lower indicates substantially reduced capacity in that particular area.

- ABAS-II

In the ABAS-II, communication skills are assessed within the Conceptual domain in the sub-

domains of Communication, and Functional Academic skills, as well as within the Social


domain in the sub-domains Leisure Skills and Social Skills. In the ABAS-II the composite

domain score for ‘Conceptual’ and ‘Social’ are reported as having a mean standard score of

100 and a standard deviation of 15, so a standard score of 70 or below in these domains is

an good indicator of substantially reduced communication capacity. In particular, the sub-

domains ‘Communication’, and ‘Functional Academic skills’, ‘Leisure Skills’, and ‘Social

Skills’ are the most relevant in evaluating communication capacity. The sub-domains have a

mean of 10 and a standard deviation of 3, so a score of 4 or lower indicates substantially

reduced communication capacity in those particular areas.

(iii) Does the individual require “significant ongoing or long term episodic support”?This assessment is similar for all people with a disability and requires an estimation of direct

support needed in relation to adaptive behaviour and maladaptive behaviour levels, taking

into consideration the network of family and community support already provided for the

individual.

The following questions may be asked, where age appropriate, to assist in determining

whether an individual with ASD requires “significant ongoing or long term episodic support”:

- Is the individual who has ASD currently receiving support?

- Who is providing this support (i.e. family, friends, and/or services)? How long has this

support been provided for?

- What sort of support is being provided? Has the individual previously requested

support from any other provider?

- Have the individual’s support needs changed? If there has been a change, is there a

known reason for this change?

- Is the individual socially vulnerable? Are there any safety issues or is the person at

risk in some way?

- Are there teaching programs that could skill the individual and reduce the risks for the

individual?

- Is the type of support being provided adequate?

- Is the frequency of the support adequate?

- Is there a need for more intense support?


- SIB-R

The SIB-R Support Score is a helpful objective measure of the level of ongoing support

needed for an individual. This measure is based on the assessed individual’s adaptive

behaviour and their maladaptive behaviours.

- Vineland-II


The Vineland-II (2005) does not provide a similar measure but adaptive behaviours

difficulties and maladaptive behaviours are both able to be assessed and a judgement made

by the clinician.


- ABAS-II

The ABAS-II also requires the assessor to make a judgement about overall support needs

from the given scores.

(iv) Is the impairment “related to ageing”?When a request to access disability services is made by, or on behalf of, a person who is

aged 65 or above and who has been diagnosed as having ASD, it is necessary to determine

if their support needs are a direct result of their age or of their ASD.

To answer this question a disability intake worker needs to determine if the areas of adaptive

behaviour concern are new or if they presented earlier in the person’s history (in some form).

In general new areas of adaptive behaviour concern will relate to the person’s age rather

than the ASD.

The following questions may be asked, where age appropriate, to assist in determining

whether the impairment is related to ageing rather than having ASD:

- At what age did the individual first present with the adaptive behaviour concern?

- Did the adaptive behaviour concern present earlier in the individual’s life in some other

way?

- Is the adaptive behaviour concern typical of individuals with ASD?

- Is the adaptive behaviour concern typical of individuals of a similar age?

- Has the individual (or their carer) previously approached an aged care provider for

support?

- Would an aged care service be better able to manage the individual’s concerns?


Appendix A Autism assessment tools1. Autism Diagnostic Interview- Revised (ADI-R; Rutter, LeCouteur, & Lord, 2003)The ADI-R is an extended interview that consists of questions focussing on three domains:

Language/ Communication; Reciprocal Social Interactions; and Restricted and Repetitive

Behaviours.

This assessment tool can be used to assess individuals from early childhood to adulthood

who have a mental age of at least two years. The only proviso is that care needs to be taken

with the assessment of very young children as children with Asperger’s Disorder may not

demonstrate behavioural symptoms until they are older.

The interviewer records and codes the interview responses. Diagnostic algorithms can then

be used to determine the presence or not of ASD. Only one score is generated to

determine if the individual has ASD or not. There are not specific algorithms for the different

diagnostic categories. A current behaviour algorithm can also be generated to help with

treatment and /or educational planning.

This assessment tool and the generated algorithm cut-off scores are considered to be valid

and reliable (Goldstein, Naglieri, & Ozonoff, 2009). However, it is important to note the

difference between an ADI-R algorithm result and a clinical diagnosis. A clinical diagnosis is

based on multiple sources of information, including all testing results, and direct observation.

2. Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore & Risi, 2002) This assessment tool is suitable for assessing individuals from early childhood to adult age.

It is a semi-structured assessment of communication, social interaction, and play abilities.

Assessment occurs through observation of structured situations, through conversation, and

through interview questions. The assessment varies according to the individual’s expressive

language ability. Module 1 is used for individuals who are pre-verbal or at single word

language level. Module 2 is used for individuals who are able to use phrase speech. Model

3 is used for children or adolescents who are verbally fluent. Module 4 is used for verbally

fluent adolescents or adults.

Separate algorithms are used for the interpretation of each module. On the basis of the cut-

off scores a diagnostic distinction is made between the individual having Autism or Pervasive

Developmental Disorder Not Otherwise Specified (PDD-NOS). The algorithms do not have a

specific Asperger’s Disorder cut-off. However, individuals with Asperger’s Disorder are likely

to satisfy either the algorithm for Autism or the algorithm for PDD-NOS.

This measure is considered to be valid and reliable (Goldstein, Naglieri and Ozonoff, 2009).


3. The Diagnostic Interview for Social and Communication Disorders (DISCO; Wing, 1994)The Diagnostic Interview for Social and Communication Disorders (DISCO, Wing, 1994) is

an extensive interview with a child’s parents. This interview consists of nearly 500 questions

and provides details about the child’s development and about a wide range of behaviours

which have ever or currently been observed from infancy upwards. This assessment tool can

be used to assess individuals from early childhood to adult age.

The diagnosis of a specific social and communication disorder is made on the basis of the

parent’s responses through use of diagnostic algorithms in the DISCO manual. Algorithms

are available for diagnosing each of the Pervasive Developmental Disorders listed in DSM-

IV-TR and ICD-10 including Autistic Disorder/Childhood Autism and Asperger’s

Disorder/Asperger’s Syndrome. A particular algorithm also identifies the more general

diagnosis of Autism Spectrum Disorder. Other algorithms are available for diagnosing other

disorders.

4. The Childhood Autism Rating Scale, Second Edition (CARS 2; Schopler et al., 2010) The Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988 and CARS

2; Schopler et al., 2010) is a behaviour scale developed to help identify children with autism

and varying degrees of the disorder. The earlier version of the CARS was helpful in

assessing individuals from early childhood to elementary and primary school age. The new

CARS 2 is good for the younger age range but is now more versatile for a wider age range

and is suitable for all age ranges. The CARS 2 includes the CARS 2-ST (the original CARS)

and the new CARS 2-HF. The CARS 2-ST is for children who have below average

intellectual ability or marked communication difficulties. The CARS 2-HF was developed to

help identify high functioning individuals with autism or Asperger’s Disorder who have an

intellectual ability of at least 80. It is very helpful in that it includes questions that are more

responsive to typical behaviours at this end of the spectrum.

CARS and CARS 2 ratings are based on the clinician’s observations and parent report.

Items are scored on a scale between 1 (within normal limits) and four (severely abnormal for

age) and are then summed and categorised. In the CARS and the CARS 2-ST summary

scores indicating the possibility of autism differ according to the age of the individual.

CARS 2-STSymptoms of ASD

Summary ScoreAll Ages under 13 years

Summary ScoreAges 13+

Minimal 15 to 29.5 15 to 27.5

Mild to moderate 30 to 36.5 28 to 34.5

Severe symptoms 37 and higher or 35 and higher


The new CARS 2-HF has different summary scores. They are for children who are verbally

fluent and over 6 years of age. They are:

CARS 2-HFSymptoms of ASD

Summary ScoreAges 6+

Minimal 15 to 27.5

Mild to moderate 28 to 33.5

Severe symptoms 34 and higher

5. Psycho-Educational Profile - Third Edition (PEP-3; Schopler, Lansing, Reichler, & Marcus, 2005) The PsychoEducational Profile - Third Edition (PEP-3; Schopler, Lansing, Reichler, &

Marcus, 2005) was developed from the PEP-R (Schopler, Reichler, Bashford, Lansing, &

Marcus, 1990) and is a standardised observational assessment that is based on a

developmental understanding of children. It is designed to evaluate the cognitive skills and

behaviours typical of children who have ASD and other developmental disabilities.

The instrument is appropriate for infants 6 months of age to children 7 years of age. It is not

dependent on the children being verbal.

The PEP-3 has two major sections that are complementary. The performance part is

administered through direct observation of the child, and the second part is completed by the

parent or caregiver.

In the performance part of the assessment, structured observations give information in 10

areas (6 of which measure developmental abilities and 4 measure maladaptive behaviours).

From these subtests three composite scores are derived – Communication, Motor skills, and

Maladaptive Behaviour. These scores are norm-referenced. The total raw score of all test

items is converted into developmental ages. Percentile scores can also be determined based

on an autism comparison sample. Scores above the 89th percentile are considered to be at

an adequate developmental/adaptive level, scores from the 75 th to the 89th percentile are

considered to be at a mildly abnormal level, scores from the 25th to the 74th percentile are

considered to be at a moderately abnormal level, and scores below the 25 th percentile are

considered to be at a severely abnormal level.

In the other part of the assessment the parent or caregiver is asked to estimate the age at

which their child is functioning in relation to communication, motor, social, thinking, and

adaptive behaviour. The PEP-3 provides information that describes the severity of the

child’s autism symptoms and gives information about the child’s developmental level.


6. The Autism Spectrum Rating Scale (ASRS; Goldstein & Naglieri, 2009) The Autism Spectrum Rating Scale (ASRS; Goldstein & Naglieri, 2009) measures

behaviours associated with ASD’s for children and youth (aged 2 to 18 years). It is

completed by parents (or caregivers) and/or teachers who rate behaviours characteristic of

the child or youth. There are 70 items in the form for children aged 2 to 5 years and 71 items

in the form for 6 to 18 year olds. The assessment derives two empirically derived scales for

children aged 2 to 5 years (Social/Communication, and Stereotypical Behaviours) and three

empirically defined scales for 6 to 18 year olds (Self-regulation, Social/Communication, and

Stereotypical Behaviours). An ARS Total Scale is also derived for all ages.

The ASRS items are also linked to DSM-IV-TR criteria and a DSM-IV-TR scale is derived.

The information provided can lead to the differential diagnosis of Autistic Disorder,

Asperger’s Disorder, and PDD-NOS.

In addition, eight treatment scales are derived. These are Peer and Adult Socialization,

Social/Emotional Reciprocity, Atypical Language, Stereotypy, Behavioural Rigidity, Sensory

Sensitivity, and Attention/Self-Regulation. These scales can help indicate the areas in which

most treatment support is needed.

7. The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) is a 65-item

questionnaire that assesses various dimensions of interpersonal behaviour, communication,

and repetitive/stereotypical behaviour of a child or adolescent from 4 to 18 years of age.

There are two forms that can be completed, one by the parent or caregiver and one by a

teacher who knows the individual well. It can be used as a screener or as an aid in the

process of clinical diagnosis. The SRS was developed with the understanding that autistic

symptoms form part of a continuum of symptoms that range in severity. For this reason it is

particularly helpful in identifying not only Autistic Disorder but also Asperger’s Disorder and

PDD-NOS.

Five subscales scores are generated as well as a Social Responsiveness Total score. The

subscales domains are: Social Awareness, Social Cognition, Social Motivation, Social

Communication, and Autistic Mannerisms. The Total score and subscale scores are

converted to a standardized T-score. T-scores of between 60 to 75 are considered to be

clinically significant and suggestive of Autism Spectrum Disorder in the mild to moderate

range. T scores above 76 are considered to be in the Severe range and strongly associated

with ASD. The subscale scores can also be used to help determine important areas of

treatment and follow-up support.


Appendix B Adaptive Behaviour Measures1. Scales of Independent Behavior – Revised (SIB-R; Bruininks, Woodcock, Weatherman, & Hill, 1996)

The Scales of Independent Behaviour – Revised (SIB-R; Bruininks, Woodcock,

Wetherman, & Hill, 1996) can be used to assess adaptive and problem behaviours of

individuals from infancy to over 80 years of age. It is designed to measure functional

independence and adaptive functioning in school, home, employment, and community

settings. The SIB-R is available in three separate forms. Each of the forms can be

administered in either a structured interview format or as a checklist completed directly by

the respondent. The three forms are:

- the Full Scale Form

- a Short Form ( a screening measure)

- an Early Development Form ( for use with children from early infancy to 6 years

of age, or older children if they are developmentally below 8 years of age)

Each of these forms also has a Problem Behaviour Scale.

The SIB-R Full Scale Form is a broad measure of adaptive behaviour for all ages. It consists

of four adaptive behaviour clusters and 14 subscales. The clusters and subscales are:

Motor skills (all ages)

- Gross Motor

- Fine Motor

Social Interaction and Communication Skills

- Social Interaction

- Language Comprehension

- Language Expressive

Personal Living Skills

- Eating and Meal preparation

- Toileting

- Dressing

- Personal Self-Care

- Domestic Skills

Community Living Skills

- Time and Punctuality

- Money and Value

- Work Skills

- Home/Community Orientation

A standard score is generated for each of the four adaptive behaviour clusters. As well, a

Broad Independence Full Scale adaptive behaviour score is generated. Each of these four


cluster scores is standardized to have a mean of 100 and a standard deviation of 15. A

developmental age for each of the subscales can also be generated.

Standard score classifications that are given as:

Adaptive level Standard Score Percentile

Very Superior 131 and above 98th – 99.9th

Superior 121-130 92nd - 97th

High Average 111-120 25th - 75th

Average 90-110 25th-75th

Low Average 80-89 9th-24th

Low 70-79 3rd-8th

Very Low 69 and below Below 1st-2nd

In addition, standardised cluster scores can be looked at in terms of functional limitations

with age-level tasks and predicting how an individual will perform if presented with tasks to

those measured in the SIB-R. The range of abilities predicted is as follows:

Skill with age level tasks Age level tasks will be

Advanced Very Easy

Age-Appropriate to Advanced Easy

Age- Appropriate Manageable

Limited to Age- Appropriate Difficult

Limited Very Difficult

Limited to Very Limited Extremely Difficult

Very Limited to Negligible Extremely Difficult to Impossible

All three SIB-R forms also include questions to address maladaptive behaviour. There are

eight problem behaviour categories. These are:

- Hurtful to Self

- Hurtful to Others

- Destructive to Property

- Disruptive Behaviour

- Unusual or Repetitive Habits

- Socially Offensive Behaviour

- Withdrawal or Inattentive Behaviour

- Uncooperative Behaviour.

These are aggregated into four indexes. These are:

- Internalized Maladaptive Index

- Asocial Maladaptive Index

- Externalized Maladaptive Index


As well, a General Maladaptive Index (which is an aggregate measure of all problem

behaviours) is also generated. The problem behaviour index scores have a mean of 0 and a

standard deviation of 10. If the scores are negative then they are lower than the mean.

A unique feature of the SIB-R is that there is a calculation of a Support Score. This

combines the individual’s adaptive level and the severity of maladaptive behaviours. The

Support Score is intended to describe an individual’s overall functional independence and

level of need for support and supervision. Support Scores range from 0 to 100. A higher

score reflects greater independence. Definitions of support levels required are:

85-100 Infrequent or no support

70-84 Intermittent or periodic support

55-69 Limited but consistent support

40-54 Frequent or close support

25-39 Extensive or continuous support

1-24 Pervasive or highly intense levels of support.

2. Vineland Adaptive Behaviour Scales, Second Edition (Vineland-II; Sparrow, Cicchetti, & Balla, 2005) The Vineland Adaptive Behaviour Scales, Second Edition (Vineland-II; Sparrow, Cicchetti, &

Balla, 2005) can be used from birth to 90 years of age and it there are a number of forms

which may be used:

- a 383-item Survey Interview Form (which the clinician conducts with the

parent/caregiver)

- a Parent/Caregiver Rating Form (which is a checklist completed by the

parent/caregiver and gives similar information to the Survey Interview Form)

- an Expanded Interview Form (which the clinician uses if more detailed

information is required)

- a Teacher Rating Form (used in relation to students who are 3 to 21 years of

age).

The possibility of using more than one form means that information may be obtained from a

number of sources, if desired.

Individuals 7 years and older, adolescents and adults are assessed in the following domains

and sub-domains:

Communication

- Receptive

- Expressive

- Written

Daily Living Skills

- Personal


- Domestic

- Community

Socialization

- Interpersonal Relationships

- Play and Leisure

- Coping Skills.

Children 6 years and 11 months of age or younger are assessed in all of the above domains

but also the Motor Skills domain (with Gross and Fine Motor sub-domains). For older

children or adults a Motor Skills domain score can be estimated.

An overall Adaptive Behaviour Composite score is also generated. The Adaptive Behaviour

Composite and each of the domains (Communication, Daily Living Skills, Socialization, and

Motor Skills) have a mean of 100 and a standard deviation of 15. Scores can range from 20

(5 SD below the mean) to 160 (4 SD above the mean).

In the Vineland-II, self-care skills are assessed within the Daily Living Skills domain in the

Personal and Domestic sub-domains. The Daily Living Skills domain is reported as a

standard score (mean of 100 and standard deviation of 15), and the sub-domains are

reported as a v-Scale Score (mean of 15 and standard deviation of 3).

The classifications for standard scores are as follows:

Adaptive level v-Scale Standard Score Percentile

High 21 or above 130 or above 98 or above

Moderately High 18-20 115-129 85-97

Adequate 13-17 86-114 16-84

Moderately Low 10-12 71-85 3-15

Low 1-9 20-70 2 or below

With further classifications if the standard score is 70 or lower as follows:

Mild Deficit 50-55 to 70

Moderate Deficit 35-40 to 50-55

Severe Deficit 20-25 to 35-40

Profound Deficit Below 20 - 25

It is also possible for children above 5 years of age, adolescents and adults to be assessed

in relation to maladaptive behaviour. The Maladaptive Behaviour Index consists of three

subscales - Internalizing, Externalizing, and Other. The Maladaptive Level given is based on

standardised ‘norms. The levels given are labelled – ‘Non-significant’ if within a normal

range, ‘Intermediate’ if within a borderline range, and ‘Significant’ if more than two standard

deviations different to the ‘normal’ population.


3. Adaptive Behaviour Assessment System – Second Edition (ABAS; Harrison & Oakland, 2003) The Adaptive Behaviour Assessment System – Second Edition (ABAS-II; Harrison &

Oakland, 2003) can be used from birth to 89 years of age. The following five forms can be

used across the age ranges:

- a Parent/Primary Caregiver Form

- a Teacher/Day Care Form for children

- an Adult Form that can be self-rated or completed by a parent or family member,

or by a supervisor or another person responsible for the individual

In the ABAS-II assesses 10 specific adaptive skills that are clustered into the following

domains and sub-domains:

Conceptual

- Communication

- Functional Academics

- Self-Direction

Social

- Social Skills

- Leisure Skills

Practical

- Home Living (or School Living, if age appropriate)

- Health and Safety

- Self-Care

- Community Use (if age appropriate)

- Work Skills (if employed)

A General Adaptive Composite score is also generated. Each composite score and the

general overall score has a mean of 100 and a standard deviation of 15. Each specific

adaptive skill has a mean of 10 and a standard deviation of 3.

The classifications for standard scores in the ABAS-II are as follows:

Adaptive level Scaled Scale Standard Score Percentile

Very High 16-19 130 or above 98th or above

High Average 14-15 120-129 91st-97th

Above Average 12-13 110-119 75th-90th

Average 8-11 90-109 25th-74th

Below Average 6-7 80-89 9th -24th

Low/Borderline 4-5 70-79 2nd-8th

Extremely Low 1-3 69 and lower Below 2nd


Appendix C Behaviour MeasureThe Developmental Behaviour Checklist (DBC, Einfeld & Tonge, 1992, 1995, 2002)The DBC includes a number of instruments for the assessment of behavioural and emotional

problems of children, adolescents and adults with developmental disabilities. The DBC-P is

a version that can be completed by parents or carers. The DBC-T is a version that can be

completed by teachers. These versions can be used for assessment of young people

between the ages of 4 to 18 years. There is also a recent version produced for assessment

of adults (DBC-A).

The DBC indicates behaviours on five subscales, as well as a Total Behaviour Problem

score. The five subscales are

- Disruptive/ Antisocial

- Self-Absorbed

- Communication Disturbance

- Anxiety

- Social Relating.

A score of above 30 (which equates to above the 60th percentile) indicates a clinical (or

concerning) level of emotional disturbance. However, even higher scores of 46 or above

above the 75th percentile) indicate levels of disturbance to a very significant level.

Specific algorithms can also be generated in relation to the specific mental health issues of

anxiety, depression, and hyperactivity.


Appendix D Eligibility for Medicare Rebate to access diagnosis and treatment

Children – Birth to 13 years

Access to diagnosis Access to treatment

Eligibility requirement Referral from consultant paediatrician or psychiatrist for assessment and diagnosis of suspected ASD

Paediatrician/psychiatrist must write referral by child’s 13th birthday and assessment be completed by child’s 15th birthday

Diagnosis of ASD confirmed by team and consultant paediatrician/psychiatrist

Paediatrician/psychiatrist must write treatment referral by child’s 13th birthday and treatment sessions be completed by child’s 15th birthday

Entitlement Access of up to four Medicare rebatable sessions with child psychiatrist, psychologist, speech therapist or occupational therapist

Access of up to twenty Medicare rebatable sessions of psychological intervention, speech therapy, or occupational therapy

All ages – Birth to adulthood

Chronic Disease Management Initiative(formally Enhanced Primary Care Plan)

Mental Health Care Plan

Eligibility requirement Diagnosis of a chronic condition (i.e. ASD)

Referral written by GP

Diagnosis of mental health condition (e.g. anxiety, depression). This diagnosis can have arisen from the GP’s assessment and concern.

Referral written by GP, paediatrician or psychiatrist

Entitlement Access of up to five Medicare rebatable sessions with an allied health practitioner.

People of Aboriginal or Torres Strait Islander descent can access up to five additional services (in total) per calendar year.

Access of up to ten Medicare rebatable sessions from psychologist, social worker or occupational therapist (to support mental health and emotional wellbeing).

Access of up to ten Medicare rebatable group sessions from psychologist, social worker or occupational therapist (to support mental health and emotional wellbeing).


Available each calendar year

Available each calendar year


Appendix E Useful contacts

AUTISM VICTORIA

Address: 24 Drummond Street, Carlton, VIC 3053, Australia

Postal Address: PO Box 374, Carlton South, VIC 3053, Australia

Phone: (03) 9657 1600

Fax: (03) 9639 4955

Web: www.autismvictoria.org.au

Autism Victoria also has a Professional ‘Adviceline’ that can be rung. Professionals

can access this line for any advice they might require.

Phone: 1300 598 272

AUSTRALIAN PSYCHOLOGICAL SOCIETY (APS)Address: Level 11, 257 Collins Street, Melbourne, VIC Postal Address: PO Box 38, Flinders Lane VIC 8009

Phone: (03) 8662 3300

Fax: (03) 9663 6177

Toll free: 1800 333 497

Email: [email protected]

Web: www.psychology.org.au

The APS website includes a list of practitioners who can undertake ASD

assessments. Refer in the website to:

Autism and Pervasive Developmental Disorders (PDD) Identified Practitioner’s List.

MENTAL HEALTH SERVICESFind a mental health service by suburb or town at:

http://www.health.vic.gov.au/mentalhealth/services/index.htm


http://www.health.vic.gov.au/mentalhealth/services/index.htm

http://www.psychology.org.au/

mailto:[email protected]

http://www.autismvictoria.org.au/

Appendix F Recommended reading and resourcesAttwood, T. (1998). Asperger's Syndrome. London: Jessica Kingsley.

Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D. (2000). Understanding other minds:

Perspectives from developmental cognitive neuroscience. New York: Oxford University

Press.

Gabriels, R. L. & Hill, D.E. (Eds.) (2007), Growing up with autism. New York: The Guilford

Press.

Goldstein, S., Naglieri, J., & Ozonoff, S. (2009). Assessment of Autism Spectrum Disorders.

New York: The Guilford Press.

Hodgdon, L.A. (1999). Solving behavior problems in autism: Improving communication

through use of visual strategies. Troy, MI: QuirkRoberts

Howlin, P.(1997). Autism – Preparing for adulthood. UK: Routledge.

Lawson, W. (2001). Understanding and working with the spectrum of autism. London:

Jessica Kingsley.

Wing, L. (1996). The Autistic Spectrum – A guide for parents and professionals. London:

Constable.

Videos

Attwood, T. (1999). Asperger Syndrome: A video guide for parents and professionals.

Arlington, TX: Future Horizon.

Eisenmajer, R. (2006). Imagine having Asperger’s Syndrome. A first consultation. (Available

directly from author).


access policy practice advice: autism spectrum disorder · web viewthe asrs items are also linked...

Documents